Revised: August 2016
SUMMARY OF PRODUCT CHARACTERISTICS
1. NAME OF THE VETERINARY MEDICINAL PRODUCT
Atopica 100 mg/ml oral solution for cats
2. QUALITATIVE AND QUANTITATIVE COMPOSITION
Each ml contains:
Ciclosporin 100 mg
all-rac- -tocopherol (E-307) 1.05 mg
Ethanol, anhydrous (E-1510) 94.70 mg
Propylene glycol (E-1520) 94.70 mg
For the full list of excipients, see section 6.1.
3. PHARMACEUTICAL FORM
Clear, yellow to brownish liquid
4. CLINICAL PARTICULARS
4.1 Target species
4.2 Indications for use, specifying the target species
Symptomatic treatment of chronic allergic dermatitis in cats.
Do not use in cases of hypersensitivity to the active substance or to any of the
Do not use in cats infected with FeLV or FIV.
Do not use in cats with a history of malignant disorders or progressive malignant
Do not vaccinate with a live vaccine during treatment or within a two-week interval
before or after treatment (see also sections 4.5 “Special precautions for use” and 4.8
“Interaction with other medicinal products”).
4.4 Special warnings for each target species
Consideration should be given to the use of other measures and/or treatments to
control moderate to severe pruritus when initiating therapy with ciclosporin.
4.5 Special precautions for use
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Special precautions for use in animals
Allergic dermatitis in cats can have various manifestations, including eosinophilic
plaques, head and neck excoriation, symmetrical alopecia and/or miliary dermatitis.
Clinical signs of allergic dermatitis such as pruritus and skin inflammation are not
specific for this disease. Other causes of dermatitis such as ectoparasitic infestations
or food allergy should be evaluated and eliminated where possible. It is good practice
to treat flea infestations before and during treatment of allergic dermatitis. A complete
clinical examination should be performed prior to treatment. The immune status of the
cats to FeLV and FIV infections should be assessed before treatment.
Any infections should be properly treated before initiation of treatment. Infections
occurring during treatment are not necessarily a reason for drug withdrawal, unless
the infection is severe.
While ciclosporin does not induce tumours, it does inhibit T-lymphocytes and
therefore treatment with ciclosporin may lead to an increased incidence of clinically
apparent malignancy due to the decrease in antitumour immune response. The
potentially increased risk of tumour progression must be weighed against the clinical
benefit. If lymphadenopathy is observed in cats being treated with ciclosporin, further
clinical investigations are recommended and treatment discontinued if necessary.
In laboratory animals, ciclosporin is liable to affect the circulating levels of insulin and
to cause an increase in glycaemia. In the presence of suggestive signs of diabetes
mellitus, the effect of treatment on glycaemia must be monitored. The use of
ciclosporin is not recommended in diabetic cats.
Cats that are seronegative for T. gondii may be at risk of developing clinical
toxoplasmosis if they become infected while under treatment. In rare cases this can
be fatal. Potential exposure of seronegative cats or cats suspected to be
seronegative to Toxoplasma should therefore be minimised (e.g. keep indoors, avoid
raw meat or scavenging). Ciclosporin was shown to not increase T. gondii oocyte
shedding in a controlled laboratory study. In cases of clinical toxoplasmosis or other
serious systemic illness, stop treatment with ciclosporin and initiate appropriate
Treatment with the product may result in decreased immune response to vaccination.
It is recommended not to vaccinate with inactivated vaccines during treatment or
within a two-week interval before or after administration of the product. For live
vaccines see also section 4.3 “Contraindications”.
Clinical studies in cats have shown that decreased appetite and weight loss may
occur during ciclosporin treatment. Monitoring of body weight is recommended.
Significant reduction in body weight may result in hepatic lipidosis. If persistent,
progressive weight loss occurs during treatment it is recommended to discontinue
treatment until the cause has been identified.
The efficacy and safety of ciclosporin has neither been assessed in cats less than 6
months of age nor weighing less than 2.3 kg.
It is not recommended to use immunosuppressive agents concomitantly.
Closely monitor creatinine levels in cats with severe renal insufficiency.
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Special precautions to be taken by the person administering the veterinary
medicinal product to animals
Wash hands after administration. In case of accidental ingestion, seek medical advice
immediately and show the package leaflet or the label to the physician. People with
known hypersensitivity to ciclosporin should avoid contact with the product.
To avoid accidental ingestion, the product must be used and kept out of reach of
children. Do not leave unattended filled syringe in the presence of children.
Avoid contact with eyes. In case of contact, rinse thoroughly with clean water.
Any uneaten medicated cat food must be disposed of immediately and the bowl
4.6 Adverse reactions (frequency and seriousness)
In 2 clinical studies with 98 cats treated with ciclosporin the following undesirable
effects were observed:
Very common: gastrointestinal disturbances such as vomiting and diarrhoea. These
are generally mild and transient and do not require the cessation of the treatment.
Common: lethargy, anorexia, hypersalivation, weight loss and lymphopenia. These
effects generally resolve spontaneously after treatment is stopped or following a
decrease in the dosing frequency.
As for the subject of malignancy, please see sections 4.3 “Contraindications” and 4.5
“Special precautions for use”.
Side effects may be severe in individual animals.
“The frequency of adverse reactions is defined using the following convention:
- very common (more than 1 in 10 animals displaying adverse reactions during the
course of one treatment)
- common (more than 1 but less than 10 animals in 100 animals)
- uncommon (more than 1 but less than 10 animals in 1,000 animals)
- rare (more than 1 but less than 10 animals in 10,000 animals)
- very rare (less than 1 animal in 10,000 animals, including isolated reports).”
4.7 Use during pregnancy, lactation or lay
The safety of the drug has neither been studied in male cats used for breeding nor in
pregnant or lactating queens. In the absence of such studies in the cat, it is
recommended to use the drug in breeding cats only upon a positive risk/benefit
assessment by the veterinary surgeon.
In laboratory animals, at doses which induce maternal toxicity (rats at 30 mg/kg BW
and rabbits at 100 mg/kg BW) ciclosporin was embryo- and foetotoxic, as indicated
by increased pre- and postnatal mortality and reduced foetal weight together with
skeletal retardations. In the well-tolerated dose range (rats at up to 17 mg/kg BW and
rabbits at up to 30 mg/kg BW) ciclosporin was without embryolethal or teratogenic
effects. In laboratory animals ciclosporin crosses the placenta barrier and is excreted
via milk. Therefore the treatment of lactating queensis not recommended.
4.8 Interaction with other medicinal products and other forms of interaction
Various substances are known to competitively inhibit or induce the enzymes involved
in the metabolism of ciclosporin, in particular cytochrome P450 (CYP 3A 4). The
compound class of azoles (e.g. ketoconazole) is known to increase the blood
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concentration of ciclosporin in cats, which is considered to be clinically relevant.
Macrolides such as erythromycin may increase the plasma levels of ciclosporin up to
twofold. Certain inducers of cytochrome P450, anticonvulsants and antibiotics (e.g.
trimethoprim/ sulfadimidine) may lower the plasma concentration of ciclosporin.
Ciclosporin is a substrate and an inhibitor of the MDR1 P-glycoprotein transporter.
Therefore, the co-administration of ciclosporin with P-glycoprotein substrates such as
macrocyclic lactones could decrease the efflux of such drugs from blood-brain barrier
cells, potentially resulting in signs of CNS toxicity. In clinical studies with cats treated
with ciclosporin and selamectin or milbemycin, there did not appear to be an
association between these drugs’ concomitant use and neurotoxicity.
Ciclosporin can increase the nephrotoxicity of aminoglycoside antibiotics and
trimethoprim. The concomitant use of ciclosporin is not recommended with these
Particular attention must be paid to vaccination (see section 4.3 “Contraindications”
and 4.5 “Special precautions for use”). Concomitant use of immunosuppressive
agents: see section 4.5 “Special precautions for use”
4.9 Amounts to be administered and administration route
For oral use.
Before starting treatment, an evaluation of all alternative treatment options should be
The recommended dose of ciclosporin is 7 mg/kg body weight (0.07 ml of oral
solution per kg) and should initially be administered daily. The frequency of
administration should subsequently be reduced depending on the response.
The product should initially be given daily until a satisfactory clinical improvement is
seen (assessed by intensity of pruritus and lesion severity - excoriations, miliary
dermatitis, eosinophilic plaques and/or self-induced alopecia). This will generally be
the case within 4-8 weeks.
Once the clinical signs of allergic dermatitis are satisfactorily controlled, the product
can then be given every second day. In some cases where the clinical signs are
controlled with every second day dosing, the veterinary surgeon can decide to give
the product every 3 to 4 days. The lowest effective frequency of dosing should be
used to maintain the remission of clinical signs.
Patients should be regularly re-evaluated and alternative treatment options reviewed.
The duration of treatment should be adjusted according to treatment response.
Treatment may be stopped when the clinical signs are controlled. Upon recurrence of
clinical signs, treatment should be resumed at daily dosing, and in certain cases
repeated treatment courses may be required.
The product can be given either mixed with food or directly into the mouth. If given
with food, the solution should be mixed with a small amount of food, preferably after a
sufficient period of fasting to ensure complete consumption by the cat. Should the cat
not accept the product mixed with food, it should be given by inserting the syringe
directly into the cat’s mouth and delivering the entire dose. In case the cat only
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partially consumes the product mixed with food, administration of the product with the
syringe should be resumed only the next day.
The efficacy and tolerability of this product was demonstrated in clinical studies with a
duration of 4.5 months.
4.10 Overdose (symptoms, emergency procedures, antidotes), if necessary
The following adverse events were seen in the case of repeated administration for 56
days at 24 mg/kg (more than 3x the recommended dose) or for 6 months at up to 40
mg/kg (more than 5x the recommended dose): loose/soft faeces, vomiting, mild to
moderate increases in absolute lymphocyte counts, fibrinogen, activated partial
thromboplastin time (APTT), slight increases in blood glucose and reversible gingival
hypertrophy. The frequency and severity of these signs were generally dose and time
dependent. At 3x the recommended dose administered daily for nearly 6 months,
changes in ECG (conduction disturbances) may occur in very rare cases. They are
transient and not associated with clinical signs. Anorexia, recumbency, loss of skin
elasticity, few or absent faeces, thin and closed eye lids may be observed in sporadic
cases at 5x the recommended dose. There is no specific antidote and in case of
signs of overdose the cat should be treated symptomatically.
4.11 Withdrawal period(s)
5. PHARMACOLOGICAL PROPERTIES
Pharmacotherapeutic group: Immunosuppressants, calcineurin inhibitors, ciclosporin.
ATCvet code: QL04AD01.
5.1 Pharmacodynamic properties
Ciclosporin (also known as cyclosporin, cyclosporine, cyclosporine A, CsA) is a
selective immunosuppressor. It is a cyclic polypeptide consisting of 11 amino acids,
has a molecular weight of 1203 daltons and acts specifically and reversibly on T
Ciclosporin exerts anti-inflammatory and antipruritic effects in the treatment of allergic
dermatitis. Ciclosporin has been shown to preferentially inhibit the activation of T-
lymphocytes on antigenic stimulation by impairing the production of IL-2 and other T-
cell derived cytokines. Ciclosporin also has the capacity to inhibit the antigen-
presenting function of the skin immune system. It likewise blocks the recruitment and
activation of eosinophils, the production of cytokines by keratinocytes, the functions
of Langerhans cells, the degranulation of mast cells and therefore the release of
histamine and pro-inflammatory cytokines.
Ciclosporin does not depress haematopoiesis and has no effect on the function of
5.2 Pharmacokinetic particulars
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The bioavailability of ciclosporin administered to cats fasted for 24 hours (either
directly into the mouth or mixed with a small amount of food) or just after feeding was
29% and 23% respectively. The peak plasma concentration is generally reached
within 1 to 2 hours when given to fasted cats or mixed with food. The absorption can
be delayed by several hours when given after feeding. In spite of differences in the
pharmacokinetics of the drug given mixed with food or directly into the mouth of fed
cats, it has been shown that the same clinical response is obtained.
In cats, the volume of distribution at steady state is about 3.3 l/kg. Ciclosporin is
widely distributed to all tissues, including the skin.
Ciclosporin is metabolised mainly in the liver by cytochrome P450 (CYP 3A 4), but
also in the intestine. Metabolism takes place essentially in the form of hydroxylation
and demethylation, leading to metabolites with little or no activity.
Elimination is mainly via the faeces. A small proportion of the administered dose is
excreted through urine as inactive metabolites.
A slight bioaccumulation related to the long half life of the drug (approximately 24h) is
observed with repeated dosing. The steady state is reached within 7 days, with a
bioaccumulation factor in the range of 1.0 to 1.72 (typically 1-2).
In the cat, there are large inter-individual variations in plasma concentrations. At the
recommended dosage, ciclosporin plasma concentrations are not predictive of the
clinical response, therefore monitoring of blood levels is not recommended.
6. PHARMACEUTICAL PARTICULARS
6.1 List of excipients
all-rac- -Tocopherol (E-307)
Ethanol, anhydrous (E-1510)
Propylene glycol (E-1520)
In the absence of compatibility studies, this veterinary medicinal product must not be
mixed with other veterinary medicinal products.
6.3 Shelf life
Shelf-life of the veterinary medicinal product as packaged for sale: 3 years.
Shelf-life after first opening the immediate packaging: 70 days.
6.4 Special precautions for storage
Store between 15°C and 30°C but preferably not below 20°C for more than one
month. Storage in the refrigerator should be avoided.
Keep the bottle in the outer carton.
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The product contains oily components from natural origin which can become solid at
lower temperatures. A jelly-like formation may occur below 20°C which is however
reversible at temperatures up to 30°C. Minor flakes or a slight sediment may still be
observed. However, this does neither affect the dosing nor the efficacy and safety of
6.5 Nature and composition of immediate packaging
Multi-dose amber glass bottle containing 5 ml or 17 ml oral solution, closed with a
rubber stopper and sealed with a screw cap. One bottle and a dispenser set
(consisting of a PE dip tube and a 1 ml PE syringe) packed in a cardboard box.
Not all pack sizes may be marketed.
6.6 Special precautions for the disposal of unused veterinary medicinal
product or waste materials derived from the use of such products
Any unused veterinary medicinal product or waste materials derived from such
veterinary medicinal product should be disposed of in accordance with local
7. MARKETING AUTHORISATION HOLDER
Novartis Animal Health UK Limited
Frimley Business Park
8. MARKETING AUTHORISATION NUMBER
9. DATE OF FIRST AUTHORISATION
16 September 2011
10. DATE OF REVISION OF THE TEXT
PROHIBITION OF SALE, SUPPLY AND/OR USE
01 August 2016
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